TBI S-O-S! Restoring a Sense-Of-Self after Brain Injury and Concussion

6. Getting Back … By Any Means Necessary

I have yet to meet (or hear from/about) anyone who sustained a brain injury, who doesn’t want to get back to where they felt they were before. We know there’s a person “in there” that we recognize. There’s gotta be. We not only don’t understand the degree to which our systems have changed, but there can also be a rigid, brittle part of us that is fixated on the idea that the person we were, is the person we’ll always be.

And we’ll do just about anything to get back to that person we were.

The crazy and amazing thing about the human spirit, is that even when things are at their worst, we manage to keep on. Even if we’re off course, even if no stars are visible high above the churning seas, even if all the fresh water is gone and there’s no sign of land, we keep on. We keep moving, keep sailing, keep on.

And in the absence of reliable patterns to navigate by, we come up with alternatives. In the absence of our usual resources, we turn to replacements. They seem like solutions, and they work – at least in part. But the mechanisms we fall back on, in the absence of a Sense-Of-Self, can take us dangerously close to the proverbial shoals… and sometimes point us direction (and deliberately) into waters where there be monsters.

When our Sense-Of-Self is impacted, everything is turned upside down. It’s not just confusing, it’s not just inconvenient. It’s a threat to our very survival. It’s trauma.

We can’t just sit there, marinating in our distress.

We have to do something. We try things. Lots of different things. Crazy things. Stupid things. Anything, really, that will get us back to feeling like “ourselves” again. Something to cut the pain. Something to stop the static. Something to quiet the chatter constantly running in the back of our minds. Something to literally numb our very real pain.

And that “something” is often comprised of choices that put us in harm’s way. Danger and direct threats to our safety provide a specific biochemical boost to our system that clears the mind of clutter and makes us feel alive again. Plunging into high-stakes dramas – dangerous, extreme situations which pose a serious threat to our safety – stimulates an autonomic response that not only clears the mind of everything “extraneous”, but also suppresses pain and pumps us full of sweet, sweet adrenaline.

Taking risks makes us feel alive, engaged, alert. To a brain that’s been slowed by injury, with delayed processing speeds that are nowhere near the “old us”, that sense of being “with it” is like a solid meal to a starving man.

It makes us feel like ourselves again. And that can be a problem.

Take our friend Junior, for example… As the unfolding scenario continues in his interrupted life.

Junior’s initial success at buying beer for his buddies continues. He hones his technique, learns the best places to buy booze, and he pushes the envelope, working his way up to buying cases. When the local bar owners catch on and stop selling to him, his football buddies ditch him. But he finds older guys at work who will buy for him, and they exchange money and goods at the back loading dock at his work. The thrill of buying from someone else hardly does it for him, however, so he takes up reselling to others in school, playing middle-man in an informal network of underage drinkers. He expands his business into drugs, including some pot and some speed, but he steers clear of the really hard stuff.

With the extra money he makes, he buys himself a nice, fast car, and he starts to rack up speeding tickets. The only thing that keeps him from losing the car is his graduation and moving out of his parents’ house to go to a college (that he barely got into) several states away. His grades never did recover fully after his concussion, and he never did get back into football. His symptoms just lasted too long, and by the time they subsided, he was too entrenched in the party life to give a shit about football or any of those jocks he used to hang out with. He got a new life — one that was almost as full of camaraderie and excitement as his football life — but that got him money and, in some ways, more thrills.

In college, the drinking and drug scene is much more pronounced, but enforcement is a lot more regular, so the thrill of peddling controlled substances disappears. If nothing else, Junior is practical. Plus, he meets up with some guys who are into extreme sports — bungee jumping, rock climbing, backwoods mountain biking, windsurfing, water skiing, and even base jumping. He gets active again, gets back in shape, and has a new bunch of friends who like to party as much as they like to push the envelope with extreme sports. Once again, he’s part of a team, part of a cohesive bunch of compadres who — much more than was ever true in high school — rely on each other intensely, sometimes for life and death.

Junior does okay in school. Not stellar, but not flunking out. He’s sure he’ll graduate and be able to get on with his life.

The only problem is, he keeps getting hurt. Not big injuries, mind you, but little things. Little stupid things. Like wiping out during water skiing, and messing up his neck and back. Like getting dumped off his board while windsurfing. Like taking some spills while mountain biking, and falling a few times while rock climbing. His buddies tease him about it, and he fights like crazy to get back after the injuries. But each time, it feels like a little more of him goes missing. He has a hard time concentrating. He has trouble with lights and noise. He loses his temper a lot. He can’t seem to hold his liquor like he used to. He gets in fights, too. His buddies stay pretty steady with him, they watch his back, and he does manage to keep up. But still, something just doesn’t feel right.

So, he pushes even harder, putting himself in more and more dangerous circumstances to get that rush, that focus, that intensity that keeps him PRESENT as nothing else can. When he’s dull and dense, he feels so stupid, so useless, and he hates feeling that way. That’s not him. It’s not who he is. But when he’s standing at the edge of a bridge high above a river gorge with his parachute strapped on… well, it’s magic. And as he’s hurtling through the air, finally — at last — he feels like himself again.

From here, the story could go in just about any direction. Junior could be killed in an accident. Or he could be arrested for assault or manslaughter, repeat the offenses while drunk or high, and spend much of his life in prison. He could experience a religious conversion and turn his life around with the help of his church. He could meet a good woman who gets him back on track. He could find work as a stuntman and do well for himself. Or he could eventually end up unemployable and on the streets with a drug/drinking problem and early onset dementia from all the hits he’s taken over the course of his life, with drug and alcohol abuse added to the debilitating mix.

Anything is possible. Any outcome — good or bad — is as likely as any other. But even knowing he could “fix” the problems to some extent won’t change the fact that losing his connection to his emerging identity when he was in high school knocked him off course. It took him on a detour that separated him from the things that mattered most to him — the things that helped him define who and what he was. And the only way out of that detour, was a series of massive adrenaline rushes that blocked out all the confusion, sharpened his senses and made him feel like he was back.

See, here’s the thing — traumatic brain injury, concussion, head injury, whatever you want to call it, can cause the processing in your brain to slow significantly. And you may not even realize it, a lot of the time. When I had my neuropsychological evaluation and the results for my processing came back significantly slower than I thought they “should be” it was pretty devastating to me. BUT it suddenly made a lot of things make sense. Especially when I looked at how I got myself back to feeling “up to speed”.

Like Junior, I was hurt in high school sports (though it was football and soccer for me, and they were in pick-up games). For all I know, I could have been hurt playing baseball or basketball, too — I just don’t remember any specific instances. And I spent a whole lot of time over the years looking for ways to pump up my adrenaline and feel like I was up to speed again. Slowing down when you want to go faster can be devastating for a teenager, and the last thing you can do is ask for help because you don’t want to look bad or seem “retarded.” I also spent a lot of time with the party crowd, driving back roads on many a night, looking for booze and smoking weed. Did I like the people I was partying with? Not always. But they accepted me for who I was, and they also stuck together when we were out on beer runs. We had that camaraderie I missed when I was out of sports. I managed to keep myself in games, even after I got hurt (people didn’t know much about concussion back then), but when the seasons were over, and the teams had all dispersed, who was I and what did I have to live for? I wasn’t entirely sure.

Now, over the years after high school, I did manage to get on with my life. I went to college (I put in four years, but didn’t manage to graduate), and I went on to find jobs and build a life I could be proud of. But that nagging sense of having lost part of myself never truly went away. And after each successive injury — the car accidents and the falls — I felt like I lost a little more of myself.

I would build back… but then I’d get hurt again.

And to compensate, to make up for things and develop some sense of myself as a unique individual, I worked my ass off in just about every area of my life. I also got in the habit of pushing the envelope — taking risks, courting danger, doing things that no sane person would do (like buying a one-way ticket to Europe while I was an unemployed college student, without enough money or any clue how I would get back). I went head-to-head with the law. I got myself in trouble (restraining order and all). I ran around with edgy people who could have gotten me killed.

Those risk-taking, danger-seeking activities made me feel ALIVE. In ways I had not felt for a long, long time. I felt so together.. so “with it”. When I was high on adrenaline, hopped up on stress hormones, all the pains and distractions of my life disappeared. They just faded away, blocked out by the biochemistry in my brain and body. Going head-to-head with a crazy drug-addled dude who lived in my apartment building might have been stupid, dangerous, and self-destructive, but when I was doing it, I felt so… “normal”. I actually felt like myself. And as bone-headed as it was to run at a police officer shouting about how wrong he was to mess with me… when I was yelling, I felt more like myself than I had in weeks.

Those kinds of activities, lame-brained as they were, offered me something that no amount of good sense could — a biochemical pump that got my brain moving at a rate of speed that made me feel like a regular person. When I wasn’t pushing the envelope, I felt so dumb, so dense, so useless. I often still do.

But as helpful as these adrenaline-producing activities have been, they have also stressed and fatigued me and set me up, biochemically, for a TBI-induced case of PTSD that’s far less “serious” than, say, a case induced by war or other violent trauma, but still had an impact. Years and years of working-working-working to get myself pumped and moving at a speed that makes me comfortable, jammed my sympathetic nervous system in permanent high gear, to the point where up until a few years ago, the idea of relaxing was so foreign to me, I had decided that there was no good reason for me to bother with doing that.

And I’ve had to train myself to relax. Deliberately. Carefully. With regular practice. Because relaxing no longer comes naturally to me.

In terms of my overall life, I have to say that TBI and the need for adrenaline rush, have walked hand-in-hand for years. And my constantly revved state contributed directly to my fall in 2004, which derailed my life and nearly cost me everything. Jammed in permanent high gear (in part because of lacking a clear sense of who I was and what place I have in the world), I was overly tired and not paying attention when I was standing at the top of those stairs. Down I went. BANG-BANG-BANG went my head. And my life turned to shit.

Had I not been injured a number of times in high school, would I have made it through in one piece? Who can say? I’d already had several concussions prior to high school, and I ‘d long had difficulties with behavior and choice-making. Hell, I was getting in TBI-related trouble when I was 12. So, I can’t lay it all at the feet of the sports concussions. But I suspect that if I hadn’t had those injuries and hadn’t lost touch (in the off-season) with the identity that sports gave me, I can’t help but wonder if I might have had a fighting chance to get myself on the good foot and form a better foundation for the rest of my life.

How fragile our self-perceptions can be, and how vulnerable our Sense-Of-Self is, in the face of what life throws at us. All of us go through shifts and changes in the course of the years – job changes, relationship changes, moves to different locales, and circles of friends widening and contracting over the course of our lives. Change is a fundamental part of the human experience, and we all have to adapt. But when it’s combined with an injury to the very faculties that help us to adjust and adapt, then you’ve got problems.

Under normal cognitive conditions, we can adapt to the changes we experience in life with a combination of past memory, present context, and hope for the future. Our memories of the past are a function of our brains as well as our biochemistry, with feelings to go with our thoughts. Hearing a song from years gone by “takes us there”, and we can be transported from our present, by dwelling on the imagined future. Both the past and the future depend on the whole system – neurological, physiological, and biochemical, to create the experiences we have and our interpretations of them, and our understanding of our present context is also heavily dependent on some level of coherence and consistency between all the different aspects of ourselves. Our experiences are more than thoughts. They are the felt sense of what life means for us – its textures, its melodies and harmonies – and they occupy our bodies, minds, and spirits, thanks to a complex, interwoven system of the most dazzling complexity.

When that system goes awry – the connections in the brain are frayed… torn… twisted… sheared… even obliterated – the rest of the system is impacted. It’s not localized only to what’s inside the skull. Everything that’s connected and related to the regions of the brain that are injured, is affected. And the cascade that results does a number on us in infinite ways, any and all of which can leave us feeling exposed and vulnerable in the worst possible ways even under the best possible conditions.

We soldier on as best we can. But something is missing. It’s something we need. It’s something we once were, but can’t seem to access anymore. It’s something we cannot live without – for it is our very Self, our identity, our core. Losing the fluidity of Self, the confidence of knowing who we are and what we can expect of ourselves is the worst of all worlds. Life keeps on rolling, it keeps on throwing things at us.

But in place of the person who used to rise to the occasion and “show up” for whatever was to come, there’s a hollow shell, a Swiss-cheese catacomb of a spirit who is unrecognizable to us. Our reactions are different, our feeling is different, the way we contact and interact with the world around us is different.

The pathways in our brains have changed – and they continue to change over weeks and months and years of continued use. Neurons that fire together, wire together, and as we muddle through our once-familiar lives, our systems can go haywire with all the confusion of our world, our muddled choices, the haphazard connections our brains are making laying in and cementing new connections that predispose us for trouble, trouble, and more trouble.

We’re cut loose from our moorings. We’re being pushed out to sea by hurricane winds. The rudder has snapped off, and the crew can’t keep the sails from catching every crosswind to push us off course. The waves rise around us, washing over the bow, slamming into the hull like cannon balls. And all we can do is hang on. Hang on and ride out the storm. Because nothing makes sense, nothing seems familiar. The last of the maps washed overboard ten leagues back, and the sextant keeps falling out of the navigator’s frozen, shaking hands.